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Childhood Brain Stem Glioma Treatment (PDQ®)

Childhood brain stem glioma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain stem.

The brain stem is the part of the brain connected to the spinal cord. It is located in the lowest part of the brain, just above the back of the neck. The brain stem is the part of the brain that controls breathing, heart rate, and nerves and muscles used in seeing, hearing, walking, talking, and eating. Most childhood brain stem gliomas are pontine gliomas, which form in a part of the brain stem called the pons.

Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia or lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. See the following PDQ treatment summaries for more information:

• Childhood Brain and Spinal Cord Tumors Treatment Overview
  
• Adult Brain Tumors

The cause of most childhood brain tumors is unknown.

The symptoms of childhood brain stem glioma vary and often depend on the child’s age and where the tumor is located.

The following symptoms and others may be caused by a brain stem glioma. Other conditions may cause the same symptoms. A doctor should be consulted if any of these problems occur:

• Loss of balance and trouble walking.
  
• Vision and hearing problems.
  
• Morning headache or headache that goes away after vomiting.
  
• Nausea and vomiting.
  
• Unusual sleepiness or change in energy level.

Tests that examine the brain are used to detect (find) childhood brain stem glioma.

The following tests and procedures may be used:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  
• MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Some childhood brain stem gliomas are diagnosed and removed in surgery.

If the tumor has not spread widely within the brain stem, a biopsy may be done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on:

• The type of brain stem glioma.
  
• Where the tumor is found in the brain and if it has spread within the brain stem.
  
• Whether or not the child has a condition called neurofibromatosis type 1.
  
• Whether the tumor has just been diagnosed or has recurred (come back).